Let that CSF Flow! A Review of the Use of Venous Sinus Stenting in the Treatment of Idiopathic Intracranial Hypertension

1. To review the clinical signs and symptoms suggestive of idiopathic intracranial hypertension (IIH).

2. To discuss the use of and procedural details that are involved in venous sinus stenting (VSS).

3. To compare VSS to alternative management in the treatment of IIH.

Background: Idiopathic intracranial hypertension (IIH) is a disorder that is characterized by increased intracranial pressure. This condition most commonly occurs in middle-aged, overweight women and presents with symptoms including chronic headaches, papilledema, tinnitus and vision loss. Although the pathogenesis of IIH is not entirely known, venous sinus stenosis is thought to be a primary cause or a secondary manifestation. Treatment of IIH includes medical management (lifestyle and pharmacology), surgical interventions, and VSS.

Clinical Findings/Procedure Details: This exhibit will provide an overview of the clinical indications and procedural details involved in VSS for IIH. We will focus on what makes an ideal candidate for VSS and certain indications for treatment. MRV and cerebral angiographic images will be provided to show areas of stenosis in select patients. Procedural details will be outlined, including pre-stenting medical optimization, catheter venography and manometry, and the stenting process itself. Angiographic images will be displayed to highlight pre-stenting stenosis and post-stenting relief of flow obstruction. VSS will then be compared to other management techniques for the treatment of IIH.

Conclusion and/or Teaching Points: IIH is a complex disorder that can be difficult to diagnose and treat. The use of VSS can provide significant symptomatic relief for patients. VSS is a safe, minimally invasive and effective alternative treatment that should be offered to patients with IIH who fail medical management. Further studies can be done to better compare VSS to other forms of surgical intervention.